11 month old Chinese female brought with concern for two episodes of emesis after family dinner. Via interpreter phone the father explains that everyone in the family vomited after dinner at home. He states the adults all vomited once and feel fine now, but the child vomited twice and he wants to ensure she is well. He is concerned that she is sick from “the onions”. When asked to clarify he explains he made a noodle dish for dinner – every ingredient has been used previously for the same recipe except for “the onions”. He then holds up a Kroger bag of what initially appear to be green onions, with the typical long green stalks and a white bulb base – but these are covered in dirt. He explains that he found them growing in their backyard and thought he’d use them for dinner, but now suspects they have made everyone sick. A brief intradepartment search procured a gardener RN who readily identified the plants – daffodils, “they just haven’t flowered yet”.

Kentucky Regional Poison Control advised that all parts of the daffodil (genus Narcissus) cause self-limited gastrointestinal symptoms for approximately 3 hours after consumption, and that care is largely supportive. There are reports of massive consumption causing CNS symptoms in dogs, but similar presentations have never been reported in humans.

Take home points:

1. Green onions and unflowered daffodils are quite similar in appearance – the classic onion odor and tearing following incision differentiates the two
2. Daffodil toxidrome is self-limited, with predominantly gastrointestinal symptoms (nausea, vomiting, diarrhea). Supportive care with oral rehydration fluid is warranted in pediatric patients.

References:

• National Capital Poison Center – http://www.poison.org/articles/2015-mar/daffodils